I 

114TH CONGRESS 

1ST SESSION H. R. 4155 

To require the Center for Medicare and Medicaid Innovation to test the 

effect of including telehealth services in Medicare health care delivery 

reform models. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 2, 2015 

Mrs. BLACK introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on 

Ways and Means, for a period to be subsequently determined by the 

Speaker, in each case for consideration of such provisions as fall within 

the jurisdiction of the committee concerned 

A BILL 

To require the Center for Medicare and Medicaid Innovation 

to test the effect of including telehealth services in Medicare health care delivery reform models. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Telehealth Innovation 

5 and Improvement Act of 2015’’. 


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1 SEC. 2. CMI TESTING OF COVERAGE OF EXPANDED TELE2 HEALTH SERVICES. 

3 (a) IN GENERAL.—Section 1115A of the Social Secu4 rity Act (42 U.S.C. 1315a) is amended— 

5 (1) in subsection (b)(2)— 

6 (A) in subparagraph (A), by adding at the 

7 end the following new sentence: ‘‘The models 

8 selected under this subparagraph shall include 

9 the model described in subparagraph (D), which 

10 shall be implemented by not later than January 

11 1, 2017.’’; and 

12 (B) by adding at the end the following new 

13 subparagraph: 

14 ‘‘(D) TELEHEALTH SERVICES IN DELIVERY

15 REFORM MODELS.—The model described in this 

16 subparagraph is a model that meets the re17 quirements of subsection (h) with respect to 

18 coverage of, and payment for, expanded tele19 health services, which shall include remote mon20 itoring services, furnished in conjunction with 

21 models that test the use of accountable care or22 ganizations under title XVIII, bundled pay23 ments under such title, and such other coordi24 nated care models under such title as the Sec25 retary determines to be appropriate.’’; 


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1 (2) in subsection (b)(4), by striking ‘‘EVALUA2 TION.—’’ and inserting ‘‘EVALUATION.—Subject to 

3 subsection (h)(6):’’; and 

4 (3) by adding at the end the following new sub5 section: 

6 ‘‘(h) MEDICARE COVERAGE OF EXPANDED TELE7 HEALTH SERVICES UNDER ACCOUNTABLE CARE ORGANI8 ZATION MODELS, BUNDLED PAYMENT MODELS, AND

9 OTHER APPROPRIATE MODELS TESTED BY THE SEC10 RETARY.— 

11 ‘‘(1) ESTABLISHMENT OF TELEHEALTH SERV12 ICE MODELS.— 

13 ‘‘(A) IN GENERAL.—Subject to the suc14 ceeding provisions of this subsection, for the 5- 

15 year period that begins on January 1, 2017, the 

16 Secretary shall test coverage of, and payment 

17 for, expanded telehealth services (as defined in 

18 paragraph (2)) furnished to applicable individ19 uals who are Medicare beneficiaries (as defined 

20 in paragraph (3)(B)) in conjunction with mod21 els tested under subsection (b), and expanded 

22 under subsection (c) (if applicable), that test 

23 the use of accountable care organizations under 

24 title XVIII, bundled payments under such title, 

25 and such other coordinated care models under 


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1 such title as the Secretary determines to be ap2 propriate. 

3 ‘‘(B) MODEL DESIGN CONSIDERATIONS.— 

4 In establishing models to be tested for enhanced 

5 telehealth services under subsection (b)(2)(D), 

6 the Secretary shall design such models in a 

7 manner to permit comparisons of Medicare 

8 beneficiaries who are participating in models 

9 under subsection (b) that include access to ex10 panded telehealth services with Medicare bene11 ficiaries in models under subsection (b) who do 

12 not have access to such services. 

13 ‘‘(2) EXPANDED TELEHEALTH SERVICES DE14 FINED.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graphs (B) and (C), in this subsection, the term 

17 ‘expanded telehealth services’ means services 

18 furnished by an eligible physician or practi19 tioner to a Medicare beneficiary as part of an 

20 episode of care for one or more of the condi21 tions specified under paragraph (4) through one 

22 or more of the following: 

23 ‘‘(i) Remote monitoring technologies, 

24 including remote device management for 

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1 gramming a medical device (such as a 

2 pacemaker or a cardiac resynchronization 

3 therapy device) outside the office of the 

4 physician specialist involved. 

5 ‘‘(ii) Bi-directional audio/video tech6 nologies. 

7 ‘‘(iii) Physiologic and behavioral moni8 toring technologies. 

9 ‘‘(iv) Engagement prompt tech10 nologies. 

11 ‘‘(v) Store and forward technologies. 

12 ‘‘(vi) Point-of-care testing tech13 nologies. 

14 ‘‘(vii) Such other technologies as the 

15 Secretary may specify. 

16 ‘‘(B) INCLUSION OF MEDICARE TELE17 HEALTH SERVICES; NONAPPLICATION OF CER18 TAIN RESTRICTIONS.— 

19 ‘‘(i) INCLUSION OF MEDICARE TELE20 HEALTH SERVICES.—The term ‘expanded 

21 telehealth services’ shall include a tele22 health service, as defined in section 

23 1834(m)(4)(F), without regard to the limi24 tations specified under section 1834(m)(4). 


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1 ‘‘(ii) RULE OF CONSTRUCTION.— 

2 Nothing in this section shall be construed 

3 as imposing a requirement on the fur4 nishing of expanded telehealth services 

5 that such services be furnished in real time 

6 through interactive audio or video tele7 communications systems between the eligi8 ble physician or practitioner and the Medi9 care beneficiary. 

10 ‘‘(iii) NO LIMITATIONS ON GEO11 GRAPHIC AREAS OR LOCATION OF PA12 TIENT.—The term ‘expanded telehealth 

13 services’ shall include services furnished 

14 (as described in subparagraph (A)) without 

15 regard to the location of the Medicare ben16 eficiary at the time the telehealth service is 

17 furnished and without regard to the area 

18 in which the Medicare beneficiary resides. 

19 ‘‘(C) REQUIREMENTS.—The term ‘ex20 panded telehealth services’ shall not include a 

21 service furnished (as described in subparagraph 

22 (A)) unless it can be demonstrated that the 

23 service, when furnished as an expanded tele24 health service, is likely to do one or more of the 

25 following: 


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1 ‘‘(i) The service assists eligible physi2 cians or practitioners coordinate care for 

3 patients. 

4 ‘‘(ii) The service enhances collabora5 tion among providers of services and sup6 pliers, including eligible physicians and 

7 practitioners, in the provision of care to 

8 patients. 

9 ‘‘(iii) The service improves quality of 

10 care furnished to patients. 

11 ‘‘(iv) The service results in reduced 

12 hospital admissions and readmissions. 

13 ‘‘(v) The service reduces or sub14 stitutes for physician office visits. 

15 ‘‘(vi) The service results in reduced 

16 utilization of skilled nursing facility serv17 ices. 

18 ‘‘(vii) The service facilitates the re19 turn of patients to the community more 

20 quickly than would otherwise occur in the 

21 absence of the service. 

22 ‘‘(3) ADDITIONAL DEFINITIONS.—In this sub23 section: 


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1 ‘‘(A) ELIGIBLE PHYSICIAN OR PRACTI2 TIONER.—The term ‘eligible physician or prac3 titioner’ means— 

4 ‘‘(i) a physician (as defined in section 

5 1861(r)); and 

6 ‘‘(ii) a practitioner (as defined in sec7 tion 1842(b)(18)(C)). 

8 ‘‘(B) MEDICARE BENEFICIARY.—The term 

9 ‘Medicare beneficiary’ means an individual who 

10 is entitled to benefits under part A or enrolled 

11 under part B of title XVIII who is not enrolled 

12 in a Medicare Advantage plan under part C of 

13 such title, an eligible organization under section 

14 1876, or a PACE program under section 1894. 

15 ‘‘(4) CONDITIONS.—For purposes of paragraph 

16 (2)(A), the conditions with respect to which a cov17 erage of an expanded telehealth service is furnished 

18 under this subsection shall include the following con19 ditions or diseases: chronic hypertension, ischemic 

20 heart diseases, chronic obstructive pulmonary dis21 ease, heart failure, heart attack, osteoarthritis, dia22 betes, chronic kidney disease, depression, atrial fi23 brillation, cancer, asthma, stroke, total hip replace24 ment procedures, total knee replacement procedures, 

25 Parkinson’s disease, and such other conditions or 


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1 diseases with respect to which the Secretary deter2 mines that expanded telehealth services would sat3 isfy one or more of the requirements of clauses (i) 

4 through (vii) of paragraph (2)(C). 

5 ‘‘(5) PAYMENT.— 

6 ‘‘(A) IN GENERAL.—Subject to subpara7 graph (B), with respect to expanded telehealth 

8 services furnished under a model tested under 

9 subsection (b) and expanded under subsection 

10 (c) (if applicable), the Secretary shall establish 

11 payment amounts under this subsection for 

12 such services. The Secretary may use one or 

13 more of the following payment methodologies 

14 for expanded telehealth services: 

15 ‘‘(i) MEDICARE FEE SCHEDULE.—Fee 

16 schedules established under title XVIII for 

17 telehealth services and remote monitoring 

18 services. 

19 ‘‘(ii) NEW FEE SCHEDULE.—A new 

20 fee schedule that the Secretary establishes 

21 for expanded telehealth services covered by 

22 reason of this subsection. 

23 ‘‘(iii) PAYMENT AMOUNTS BASED ON

24 SHARED RISK.—A payment methodology 

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1 signed to ensure savings with respect to 

2 expanded telehealth services covered under 

3 the model. 

4 ‘‘(B) CONSIDERATION OF CERTAIN

5 COSTS.—In determining the amount of payment 

6 for an expanded telehealth service under the 

7 payment methodologies referred to in subpara8 graph (A), the Secretary shall take into account 

9 costs incurred by eligible physicians and practi10 tioners— 

11 ‘‘(i) for the acquisition and implemen12 tation information systems necessary to 

13 furnish such services, including costs of 

14 equipment and requisite software; 

15 ‘‘(ii) for nonphysician clinical per16 sonnel in conjunction with such service; 

17 and 

18 ‘‘(iii) for physician interpretation of 

19 clinical data through the expanded tele20 health service as well as for the supervision 

21 or oversight of the system for such service. 

22 ‘‘(6) EVALUATION OF MODELS.— 

23 ‘‘(A) USE OF INDEPENDENT ENTITY.—In 

24 lieu of the evaluations conducted by the Sec25 retary under subsection (b)(4) for models tested 


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1 under subsection (b), the Secretary shall pro2 vide for evaluations of enhanced telehealth serv3 ice models under subsection (b)(2)(D) by an 

4 independent entity. Such evaluation shall be 

5 conducted with respect to the specific enhanced 

6 telehealth service and condition or conditions 

7 involved that are tested under such models. 

8 ‘‘(B) TIMING OF EVALUATION.—An eval9 uation of such enhanced telehealth service and 

10 condition or conditions involved conducted by 

11 the independent entity under this paragraph 

12 shall begin three years after the implementation 

13 of the model that provides for coverage of and 

14 payment for the expanded telehealth service 

15 with respect to such condition. 

16 ‘‘(C) CRITERIA.—An evaluation of such en17 hanced telehealth service models conducted by 

18 the independent entity under this paragraph 

19 shall include an analysis of— 

20 ‘‘(i) the quality of care furnished 

21 under the model, including the measure22 ment of patient-level outcomes and patient23 centeredness criteria determined appro24 priate by the Secretary; 


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1 ‘‘(ii) the changes in spending under 

2 parts A and B of title XVIII by reason of 

3 the model, taking into account costs and 

4 savings under such parts across the con5 tinuum of care for the episode of care and 

6 condition or conditions involved; and 

7 ‘‘(iii) any impediments that were en8 countered under the model, such as— 

9 ‘‘(I) explicit telehealth restric10 tions under Federal or State laws that 

11 are not related to health care reim12 bursement, such as scope of practice 

13 limitations; 

14 ‘‘(II) licensing or credentialing 

15 barriers; and 

16 ‘‘(III) limited broadband access 

17 or limited health information tech18 nology capabilities. 

19 ‘‘(D) INFORMATION.—The provisions of 

20 subsection (b)(4)(B) shall apply to evaluations 

21 conducted under this paragraph in the same 

22 manner as such provisions apply to evaluations 

23 conducted under subsection (b)(4). 

24 ‘‘(7) APPLICATION OF EXPANDED TELEHEALTH

25 SERVICES TO ALL CMI MODELS.—The Secretary 


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1 shall expand the application of an enhanced tele2 health service with respect to the condition or condi3 tions involved to all models tested under subsection 

4 (b), and expanded under subsection (c) (if applica5 ble), that apply with respect to services furnished 

6 under title XVIII to provide for coverage of, and 

7 payment for, such enhanced telehealth service or 

8 services with respect to such condition or conditions 

9 under all such models for years beginning after the 

10 5-year period described in paragraph (1)(A) if— 

11 ‘‘(A) the independent evaluation conducted 

12 under paragraph (6) with respect to such mod13 els demonstrates that such enhanced telehealth 

14 service or services with respect to the condition 

15 or conditions involved resulted in— 

16 ‘‘(i) reduced spending under parts A 

17 and B of title XVIII without reducing the 

18 quality of care; or 

19 ‘‘(ii) improved quality of patient care 

20 without increasing such spending; and 

21 ‘‘(B) the Chief Actuary of the Centers for 

22 Medicare & Medicaid Services certifies that 

23 such expansion would reduce net program 

24 spending under parts A and B of title XVIII.’’. 


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1 (b) COVERAGE OF AND PAYMENT FOR CERTAIN EN2 HANCED TELEHEALTH SERVICES THAT ARE CERTIFIED

3 AS PROVIDING SAVINGS UNDER THE MEDICARE PRO4 GRAM.— 

5 (1) COVERAGE.—Section 1834 of the Social Se6 curity Act (42 U.S.C. 1395m) is amended by adding 

7 at the end the following new subsection: 

8 ‘‘(s) CERTIFIED ENHANCED TELEHEALTH SERV9 ICES.— 

10 ‘‘(1) IN GENERAL.—The Secretary shall pay for 

11 certified enhanced telehealth services (as defined in 

12 paragraph (2)(A)) furnished by a physician (as de13 fined in section 1861(r)) or a practitioner (as de14 fined in section 1842(b)(18)(C)) to a Medicare fee15 for-service beneficiary (as defined in paragraph 

16 (2)(B)) for one or more of the conditions specified 

17 under section 1115A(h)(4) in an amount determined 

18 under paragraph (3) without regard to— 

19 ‘‘(A) the location of the Medicare fee-for20 service beneficiary at the time the certified en21 hanced telehealth service is furnished; and 

22 ‘‘(B) the area in which the Medicare fee23 for-service beneficiary resides. 

24 ‘‘(2) DEFINITIONS.—In this subsection: 


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1 ‘‘(A) CERTIFIED ENHANCED TELEHEALTH

2 SERVICE.—The term ‘certified enhanced tele3 health service’ means, with respect to a condi4 tion or conditions specified under section 

5 115A(h)(4), an enhanced telehealth service (as 

6 defined in section 1115A(h)(2)) with respect to 

7 which— 

8 ‘‘(i) an independent evaluation con9 ducted under section 1115A(h)(6) dem10 onstrates that the service tested under a 

11 model under section 1115A(b)(2)(D) with 

12 respect to the condition or conditions re13 sulted in— 

14 ‘‘(I) reduced spending under 

15 parts A and B without reducing the 

16 quality of care; or 

17 ‘‘(II) improved quality of patient 

18 care without increasing such spend19 ing; and 

20 ‘‘(ii) the Chief Actuary of the Centers 

21 for Medicare & Medicaid Services certifies 

22 that such expansion would reduce net pro23 gram spending under such parts. 

24 ‘‘(B) MEDICARE FEE-FOR-SERVICE BENE25 FICIARY.—The term ‘Medicare fee-for-service 


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1 beneficiary’ has the meaning given such term in 

2 section 1899(h)(3). 

3 ‘‘(3) PAYMENT AMOUNT.—The amount of pay4 ment for certified enhanced telehealth services shall 

5 be determined in the same manner as payments for 

6 enhanced telehealth services are determined under 

7 section 1115A(h)(5).’’. 

8 (2) PAYMENT.—Section 1833(a)(1) of the So9 cial Security Act (42 U.S.C. 1395l(a)(1)) is amend10 ed by striking ‘‘and’’ before ‘‘(Z)’’ and inserting be11 fore the semicolon at the end the following: ‘‘, and 

12 (AA) with respect to certified enhanced telehealth 

13 services (as defined in section 1834(s)(2)(A)), the 

14 amount paid shall be an amount equal to 80 percent 

15 of the lesser of the actual charge for the services or 

16 the amount determined under section 1834(s)(3)’’. 

Æ 


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